| NPI | 1780109769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist Clinical (Licence: PA PS018322) | |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2023-04-19 |